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Choline Supplementation in Cystic Fibrosis—The Metabolic and Clinical Impact

1
Department of Neonatology, Children’s Hospital, Eberhard-Karls-University, 72076 Tübingen, Germany
2
Department of General Pediatrics, Hematology and Oncology, Children’s Hospital, Eberhard-Karls-University, 72076 Tübingen, Germany
3
Center for Pediatric Clinical Studies, Children’s Hospital, Eberhard-Karls-University, 72076 Tübingen, Germany
4
Department of Diagnostic and Interventional Radiology, Medical Faculty, Eberhard-Karls-University, 72076 Tübingen, Germany
5
University Pharmacy, Medical Faculty, Eberhard-Karls-University, 72076 Tübingen, Germany
*
Author to whom correspondence should be addressed.
Joachim Riethmülle, deceased on 31 August 2017.
Nutrients 2019, 11(3), 656; https://doi.org/10.3390/nu11030656
Received: 6 February 2019 / Revised: 8 March 2019 / Accepted: 12 March 2019 / Published: 18 March 2019
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Abstract

Background: Choline is essential for the synthesis of liver phosphatidylcholine (PC), parenchymal maintenance, bile formation, and lipoprotein assembly to secrete triglycerides. In choline deficiency, the liver accretes choline/PC at the expense of lung tissue, thereby impairing pulmonary PC homoeostasis. In cystic fibrosis (CF), exocrine pancreas insufficiency results in impaired cleavage of bile PC and subsequent fecal choline loss. In these patients, the plasma choline concentration is low and correlates with lung function. We therefore investigated the effect of choline supplementation on plasma choline/PC concentration and metabolism, lung function, and liver fat. Methods: 10 adult male CF patients were recruited (11/2014–1/2016), and orally supplemented with 3 × 1 g choline chloride for 84 (84–91) days. Pre-/post-supplementation, patients were spiked with 3.6 mg/kg [methyl-D9]choline chloride to assess choline/PC metabolism. Mass spectrometry, spirometry, and hepatic nuclear resonance spectrometry served for analysis. Results: Supplementation increased plasma choline from 4.8 (4.1–6.2) µmol/L to 10.5 (8.5–15.5) µmol/L at d84 (p < 0.01). Whereas plasma PC concentration remained unchanged, D9-labeled PC was decreased (12.2 [10.5–18.3] µmol/L vs. 17.7 [15.5–22.4] µmol/L, p < 0.01), indicating D9-tracer dilution due to higher choline pools. Supplementation increased Forced Expiratory Volume in 1 second percent of predicted (ppFEV1) from 70.0 (50.9–74.8)% to 78.3 (60.1–83.9)% (p < 0.05), and decreased liver fat from 1.58 (0.37–8.82)% to 0.84 (0.56–1.17)% (p < 0.01). Plasma choline returned to baseline concentration within 60 h. Conclusions: Choline supplementation normalized plasma choline concentration and increased choline-containing PC precursor pools in adult CF patients. Improved lung function and decreased liver fat suggest that in CF correcting choline deficiency is clinically important. Choline supplementation of CF patients should be further investigated in randomized, placebo-controlled trials. View Full-Text
Keywords: cystic fibrosis; choline deficiency; choline supplementation; lung function; liver; steatosis; magnetic resonance spectroscopy; stable isotope labeling cystic fibrosis; choline deficiency; choline supplementation; lung function; liver; steatosis; magnetic resonance spectroscopy; stable isotope labeling
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Bernhard, W.; Lange, R.; Graepler-Mainka, U.; Engel, C.; Machann, J.; Hund, V.; Shunova, A.; Hector, A.; Riethmüller, J. Choline Supplementation in Cystic Fibrosis—The Metabolic and Clinical Impact. Nutrients 2019, 11, 656.

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